Sepatated ovarian cyst and nipple discharge with atypical cells

I am premenopausal 40, have had 4 children, all breastfed, and have 2 problems now, in addition to my hypothyroid, blood pressure, and antiphospholipid syndrome.  I have a 9.8cm septated cyst on left ovary and am awaiting the appointment with the gyn/oncologist.  Meanwhile, I have had yellow serous nipple discharge from one duct on left breast for over 1 year.  I was getting this checked out when it came time for the annual pelvic.  The nipple discharge is negative for blood, negative mammogram and ultrasound, but is now showing atypical cells on a pap test.  The breast surgeon (I had to push for a referral to him after the negative mammogram and ultrasound and after I was told not to worry about it) has now prescribed a month course of antibiotics--cipro--which I see could interact with the warfarin and which he says should get rid of the atypical cells.  Could these two issues be related?  What exactly does atypical pap cells mean for the breast and infection?  I am worried that the two issues might be connected and that the wait and see approach might not be the best idea.

[Annekathryn Goodman, M.D.]

Hi There,

First of all, you need to have that ovarian cyst removed surgically. Most cysts are benign but cysts over 4 cm will not resolve. They are unlikely to be functional cysts (that is - related tp your normal ovarian cycle of ovulation). Most cysts this size are benign tumor. But they can grow and twist and cause pain.
Rarely, these cysts are cancerous. So surgery is the next step.

As for the nipple discharge, it is unlikely to be associated. It may be that your other medical  conditions cause you to have an elevated prolactin level which then stimulates your breast. Prolactin, the milk hormone, comes from your pituitary.

another possibility is a small papilloma in the breast duct system.There are times one might get a ductogram to check that out.

if you google breast ductogram you will get alot of good information on this.
here is one site
http://emedicine.medscape.com/article/347305-overview

you can also go to the medhelp breast forum. I am not a breast surgeon so there may be other things that I am not thinking of.

it sounds like your breast surgeon thinks this is an infection

the word atypical can mean anything from from inflamed to precancerous so it is hard to know what that cytology means without a biopsy.

I hope everything works out
take care

[LibraryLisa]

Thank you for your response.  Finally met with the gyn/oncologist today.  She said this is not an emergency (the cyst has one thin septation and no solid areas and my CA-125 is 15) so I can schedule surgery at my own leisure and that we could do this laparoscopically. The doc did an endometrial biopsy, as the reason for the initial visit that led to finding the cyst was a prolongued period.   I have to start dissertation work soon, so would like to get the surgery over with quickly.  The doc recommends removal of ovary with the cyst and also removal of the uterus.  At first she suggested total hysterectomy, but I said, at 40, I am too young to not have an ovary (assuming no cancer, of course).  Finally, due to my antiphospholipid syndrome, she prescribed Lovenox (I have been off the warfarin in preparation for the surgery).  The Lovenox costs $1,300 for 10 days worth.  I am a grad student with 4 kids, a mother and a sister to care for, so of course I don't have that amount of cash on hand.  The student insurance doesn't cover it and because of the insurance, I don't qualify for assistance.  I am going to ask if we could do heparin instead.  My questions: 1.  Is this really something that can wait a while?  If this is not considered an emergency situation, I worry the insurance company won't cover it at all (they don't cover much beyond the flu and other young student ailments). 2. Do we really need to remove the uterus if no signs of cancer are present?  I am young still and, though I have no plans for more children, would like to have a uterus as I enjoy my uterine orgasms.  I don't think this is something I want to give up quite yet. 3. If I don't have the uterus removed, will this make for a more complicated cyst removal or will we not be able to do the surgery laparoscopically? Help please, as I am trying to get surgery arranged for Wednesday so that I can be ready to teach when the semester starts.

[Annekathryn Goodman, M.D.]

Hi There
I defer to the doctor who saw you and examined you but surgery sounds very reasonable
good luck with everything!